Medicaid is paying for housing, food in more states

Today’s edition: A bipartisan duo in the Senate is introducing a new version of their insulin bill, and major antiabortion groups blast former president Donald Trump for saying the Supreme Court left abortion policy up to the states. But first …

Nineteen states are experimenting with more holistic Medicaid benefits

An experiment within the Medicaid program is picking up steam as states look to cover services addressing more than just enrollees’ medical needs.

The new flexibilities have been approved in 19 blue and red states, dovetailing the Biden administration’s goals to reduce diet-related diseases and homelessness in the United States. Depending on the rules for each state, Medicaid funds can be used to pay for rent, utilities or other medically necessary housing accommodations. They can also cover nutrition counseling and education, clinically tailored meals or pantry stocking.

• “We’re coming up on this time where these [programs] reflect state and administrative goals, and these Medicaid demonstrations are being prioritized by both,” said Elaine Chhean, special assistant to the executive director at the National Academy for State Health Policy.

The bigger picture: Supporters argue that by investing in nonmedical factors affecting people, like housing or food security, states could improve their resident’s health and lower health-care spending. Most of the programs are still in their infancy, though, so states are still evaluating whether the cost of those social support services will outpace potential savings.

Housing support

Access to clean, safe and affordable housing has been identified as one of the most basic and crucial keys to good health. Compared with people with stable housing, homeless patients are more likely to seek care in emergency rooms, have longer hospital stays and more frequent readmissions — fueling persistently high health-care costs for that population.

Last month, New Jersey received approval under a Section 1115 waiver from the Centers for Medicare and Medicaid Services for a pilot program that will allow the state to use Medicaid funds to help people with housing and other social services. Federal regulators signed off on similar initiatives in Arkansas, Arizona, Massachusetts and Oregon last fall.

In some cases, as in Arizona and Oregon, the program can pay up to six months’ rent for qualifying individuals. In other instances, the funds can’t be directly used for rent but can cover one-time move-in expenses, like a security deposit, and improvements, such as mold removal or air-conditioning installment.

The catch: Not all Medicaid enrollees qualify for the extra benefits. While the criteria varies by state, most programs require enrollees to demonstrate at least one health risk factor and one social risk factor, like having a chronic condition and experiencing housing instability.

On our radar: California and New York are among the states seeking to create similar pilot programs offering short-term rental assistance. Other states, including Rhode Island, New Mexico and West Virginia, have submitted proposals to CMS to use Medicaid dollars to offer other housing-related services, according to KFF’s waiver tracker.  

Former Oregon governor Kate Brown (D):

Food as medicine

Most of the states with Medicaid waivers to address housing needs are also pursuing food-as-medicine initiatives.

In several states, Medicaid can now pay for nutrition counseling and education, medically tailored meals, pantry stocking and produce prescriptions, where physicians offer low-income patients with diet-related chronic illnesses vouchers for free fruits and vegetables. The goal is to see whether providing low-income Americans with nutritious foods can help turn the tide on diet-related diseases and food insecurity in the United States.

Why it matters: There are roughly 34 million people experiencing food insecurity in America, according to the Department of Agriculture. Meanwhile, chronic and diet-related illnesses, including cardiovascular disease, stroke and diabetes, are among the leading causes of death nationwide. 

Several state officials told The Health 202 that one of their greatest hurdles to getting these pilot programs off the ground is coordinating the new benefits with existing social services that might not be used to working with Medicaid, such as the Supplemental Nutrition Assistance Program, also known as SNAP.

• “This isn’t about substituting one for the other,” said Suzanne Wikle, a senior policy analyst at the Center for Law and Social Policy. “It’s really thinking about how we are using all of our resources collectively to best support people who aren’t able to meet their basic needs or are in a health crisis.” 

Rep. Jim McGovern (D-Mass.), leader of the bipartisan Food is Medicine working group:

Does it work?

North Carolina’s Medicaid program has been experimenting with paying for nonmedical needs for years — but the jury’s still out on whether it’s moving the needle.

In 2018, the federal government authorized up to $650 million in Medicaid funding for the state’s Healthy Opportunities Pilots. The first-of-its-kind program provides food, housing and transportation services for qualifying beneficiaries in three regions across the state.

Those benefits kicked in last year. Healthy food boxes, produce prescriptions and case managers to help enrollees obtain and remain stably housed are among the services in highest demand, according to Amanda Van Vleet, the associate director of innovation for North Carolina’s Medicaid program.

Van Vleet told The Health 202 that an evaluation of the pilot is underway in anticipation of its expiration in October 2024. North Carolina officials are trying to assess whether the initiative successfully reduced participants’ emergency department use or rehospitalizations, increased screenings for social risk factors, connected more people to social services and lowered health-care costs.

More from Van Vleet:

In the courts

On tap today: The Supreme Court has given itself until 11:59 p.m. tonight to decide how accessible an abortion pill should be nationwide. Here are some of the ways the Supreme Court could respond. 

Also of note: The Texas federal judge who invalidated Obamacare’s mandate that insurers cover certain preventive services declined to put a pause on the ruling, at least for now. He asked the Biden administration for more information to back up claims that this would disrupt health coverage for Americans.

On the Hill

Bipartisan duo to introduce a new version of their insulin bill

New this a.m.: Sens. Jeanne Shaheen (D-N.H.) and Susan Collins (R-Maine) are introducing a new version of their bill aimed at the cost of insulin.

The legislation would limit out-of-pocket costs for at least one type and dosage form of insulin for those with private insurance to no more than $35 per month or 25 percent of the list price per month. The legislation also prohibits pharmacy benefit managers from placing certain utilization management tools, like prior authorization, on products with capped costs; requires PBMs pass through all insulin rebates to plan sponsors; mandates a report to Congress on biosimilar insulin competition and more.

• The revamped bill is still in the process of getting a score from the Congressional Budget Office, according to Sarah Weinstein, a spokesperson for Shaheen.

This comes as key Senate leaders are racing to ready health legislation for a potential bipartisan package, which is expected to include insulin-related measures. Senate Majority Leader Chuck Schumer (D-N.Y.) is “committed to getting a $35 insulin bill passed and the details are still being worked out,” a spokesperson said in a statement.

There’s already another bipartisan insulin bill out from Sens. Raphael Warnock (D-Ga.) and John Kennedy (R-La.), which is aimed at capping out-of-pocket costs for the lifesaving medication at $35 per month for both Americans with private insurance and the uninsured.

In other Hill news …

Here’s something we’re watching: Nearly 230 national and state groups are urging congressional leadership to oppose any policies that would amount to cutting funding for Medicaid.

The letter sent yesterday — led by Families USA, a liberal consumer health lobby — comes one day after House Republicans released their plan to raise the debt ceiling into next year. The package includes a controversial plan to require low-income Americans to work or risk being kicked off the safety net program, and the letter expresses opposition to such work rules.

Chiquita Brooks-LaSure, Biden’s CMS chief:

Reproductive wars

Prominent antiabortion groups criticize Trump

Leading antiabortion groups are hitting former president Donald Trump for his position on abortion.

In a statement to The Post, campaign spokesman Steven Cheung wrote that Trump “believes that the Supreme Court, led by the three Justices which he supported, got it right when they ruled this is an issue that should be decided at the State level.”

That prompted SBA Pro-Life America to put out a news release calling Trump’s position “a morally indefensible position for a self-proclaimed pro-life presidential candidate to hold.” Marjorie Dannenfelser, the group’s president, said her organization will oppose presidential candidates who don’t back a federal minimum limit on abortion at 15 weeks of pregnancy.

Recently, Dannenfelser told The Health 202 that SBA Pro-Life America would likely ask candidates to sign a pledge supporting such nationwide restrictions. In the 2016 cycle, Dannenfelser was instrumental in extracting antiabortion promises from Trump.

Kristan Hawkins, president of Students for Life Action, also criticized Trump:

Industry Rx

Narcan manufacturer aims to sell overdose antidote at about $50 a kit

The nasal spray that reverses opioid overdoses will sell for “less than $50” per kit, the drug’s manufacturer announced yesterday, spurring criticism that the price for the over-the-counter medication could put it out of reach for those who need it most, our colleague David Ovalle reports.

The announcement from Emergent BioSolutions comes weeks after the Food and Drug Administration approved Narcan for sale without a prescription — a highly sought move that harm reduction groups say is aimed at boosting access to the lifesaving medication. But advocates have long worried the price the company ultimately sets may be a barrier.

The two-dose kits will be available on U.S. shelves, and available for online purchase, by late summer, according to Emergent. Individual retailers will ultimately decide how much to charge per kit, but the company said its goal is for Narcan’s retail price to be “consistent with our public interest price.” 

• Emergent has charged local and state health departments, harm-reduction groups and first responders about $47 per kit in recent years — a retail price advocates say they fear is too expensive for many Americans.

In other health news

• Data point: States that have enacted abortion bans since the Supreme Court overturned Roe v. Wade in June saw a 10.5 percent drop in applications for OB/GYN residency programs in 2023 compared with the previous year, The Post’s Fenit Nirappil and Frances Stead Sellers report, citing data out this morning from the Association of American Medical Colleges.
• In North Dakota: Republican Gov. Doug Burgum signed a bill yesterday banning gender-affirming care for most minors in the state. The measure, which took effect immediately upon Burgum’s signature, received veto-proof support from GOP lawmakers in the state legislature, Trisha Ahmed reports for the Associated Press.
• On the move: Seema Verma, who was CMS administrator under Trump, has been tapped to serve as Oracle’s new senior vice president and the general manager of its clinical trials business, the company announced yesterday.

Quote of the week

Health reads

What to know about misoprostol, the second drug in medication abortions (By Niha Masih | The Washington Post)

The NIH has poured $1 billion into long Covid research — with little to show for it (By Rachel Cohrs and Betsy Ladyzhets | Stat)

The Fight Over a Drug That Is Great for Horses but Horrific for Humans (By Jan Hoffman | The New York Times)

Patients were told their voices could disappear. They turned to AI to save them. (By Amanda Morris, Alexa Juliana Ard and Szu Yu Chen | The Washington Post)

Sugar rush

Thanks for reading! See y’all Monday.